ICD-10 Coding for Facet Syndrome(M54.5, M53.88)
Complete ICD-10-CM coding and documentation guide for Facet Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Facet Syndrome
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.5 | Low back pain | Use when diagnosing axial lumbar pain without confirmed structural changes. |
|
| M53.88 | Other specified dorsopathies | Use when imaging confirms facet hypertrophy or arthropathy. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for facet syndrome
Essential facts and insights about Facet Syndrome
Primary ICD-10-CM Codes for facet syndrome
Decision Criteria
clinical Criteria
- Presence of chronic low back pain without radicular symptoms
Applicable To
- Axial lumbar pain
Excludes
- Radiculopathy (M54.1-)
Clinical Validation Requirements
- Chronic low back pain without specific structural changes
- Pain localized to lumbar region
Code-Specific Risks
- Overuse without imaging confirmation
- Misclassification of radicular pain
Coding Notes
- Ensure documentation specifies absence of radicular symptoms.
M53.88 - Other specified dorsopathies
Use when imaging confirms facet hypertrophy or arthropathy.
Applicable To
- Facet hypertrophy
- Facet arthropathy
Excludes
- Spondylosis (M47.-)
Clinical Validation Requirements
- Imaging confirmation of facet hypertrophy or arthropathy
- Pain correlating with imaging findings
Coding Notes
Document imaging findings clearly to support this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Facet Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.5.
Impact
Clinical: May not justify the need for intervention, Regulatory: Non-compliance with payer requirements, Financial: Potential for claim denial
Mitigation Strategy
Always document pain duration, Include conservative treatment history
Impact
Reimbursement: Incorrect billing for levels can lead to denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on treatment levels.
Mitigation Strategy
Use the N-1 formula to convert nerve blocks to levels.
Impact
Improper billing for facet joint interventions
Mitigation Strategy
Ensure documentation supports the number of levels and laterality billed.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Facet Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Facet Syndrome
Use these documentation templates to ensure complete and accurate documentation for Facet Syndrome. These templates include all required elements for proper coding and billing.
Chronic lumbar facet pain
Specialty: Pain ManagementRequired Elements
- Pain duration
- Specific spinal levels
- Failed conservative treatments
- Imaging findings
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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